Bottom Line:
Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs.Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026).No significant difference between the 2 treatment regimens was found for the other outcome measures.

ABSTRACTMeta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs. The aim of the present study was to perform an updated meta-analysis on the efficacy of progesterone versus progesterone plus estrogen as luteal phase support. We searched the MEDLINE, Cochrane Library, and Google Scholar databases (up to March 18, 2014). The search terms were (estrogen OR estradiol OR oestradiol) AND (progesterone) AND (IVF OR in vitro fertilization) AND (randomized OR prospective). We did not limit the form of estrogen and included subjects who contributed more than 1 cycle to a study. The primary outcome was clinical pregnancy rate. Secondary outcomes were ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate. A total of 11 articles were included in the present analysis, with variable numbers of studies assessing each outcome measure. Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026). No significant difference between the 2 treatment regimens was found for the other outcome measures. Progesterone plus estrogen for luteal phase support is associated with a higher clinical pregnancy rate than progesterone alone in women undergoing IVF, but other outcomes such as ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate are the same for both treatments.

Mentions:
Of the 11 studies, 9 studies reported clinical pregnancy rate (Table 5).17–19,21–23,25–27 P + E was more likely to result in a clinical pregnancy than P alone (pooled OR = 1.617, 95% CI 1.059–2.471; P = 0.026) (Figure 2A). A random-effects model was used, as there was heterogeneity among the studies (Q = 25.45, P = 0.001; I2 = 68.57). Pooled ORs remained >1.0 as each study was removed in turn. In 5 instances, the pooled ORs became nonsignificant after each of those 5 studies was removed, but since their P values were borderline and near the threshold with points in the same direction, influence from any of these 5 studies on the overall pooled OR (without study removal) is negligible (Figure 2B). The funnel plot with the Egger test (Figure 2C) was performed to evaluate publication bias in these studies, and with an estimated intercept of −0.157, and a 1-tailed P = 0.477, there is no significant asymmetry or bias (Figure 2C).

Mentions:
Of the 11 studies, 9 studies reported clinical pregnancy rate (Table 5).17–19,21–23,25–27 P + E was more likely to result in a clinical pregnancy than P alone (pooled OR = 1.617, 95% CI 1.059–2.471; P = 0.026) (Figure 2A). A random-effects model was used, as there was heterogeneity among the studies (Q = 25.45, P = 0.001; I2 = 68.57). Pooled ORs remained >1.0 as each study was removed in turn. In 5 instances, the pooled ORs became nonsignificant after each of those 5 studies was removed, but since their P values were borderline and near the threshold with points in the same direction, influence from any of these 5 studies on the overall pooled OR (without study removal) is negligible (Figure 2B). The funnel plot with the Egger test (Figure 2C) was performed to evaluate publication bias in these studies, and with an estimated intercept of −0.157, and a 1-tailed P = 0.477, there is no significant asymmetry or bias (Figure 2C).

Bottom Line:
Meta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs.Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026).No significant difference between the 2 treatment regimens was found for the other outcome measures.

ABSTRACTMeta-analyses have found conflicting results with respect to the use of progesterone or progesterone plus estrogen as luteal phase support for in vitro fertilization (IVF) protocols involving gonadotropins and/or gonadotropin-releasing hormone analogs. The aim of the present study was to perform an updated meta-analysis on the efficacy of progesterone versus progesterone plus estrogen as luteal phase support. We searched the MEDLINE, Cochrane Library, and Google Scholar databases (up to March 18, 2014). The search terms were (estrogen OR estradiol OR oestradiol) AND (progesterone) AND (IVF OR in vitro fertilization) AND (randomized OR prospective). We did not limit the form of estrogen and included subjects who contributed more than 1 cycle to a study. The primary outcome was clinical pregnancy rate. Secondary outcomes were ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate. A total of 11 articles were included in the present analysis, with variable numbers of studies assessing each outcome measure. Results of statistical analyses indicated that progesterone plus estrogen treatment was more likely to result in clinical pregnancy than progesterone alone (pooled odds ratio 1.617, 95% confidence interval 1.059-2.471; P = 0.026). No significant difference between the 2 treatment regimens was found for the other outcome measures. Progesterone plus estrogen for luteal phase support is associated with a higher clinical pregnancy rate than progesterone alone in women undergoing IVF, but other outcomes such as ongoing pregnancy rate, fertilization rate, implantation rate, and miscarriage rate are the same for both treatments.